无血缘关系供者异基因外周血干细胞移植治疗急、慢性白血病49例  

Unrelated-donor peripheral blood stem cell transplantation for patients with acute/chronic leukemia:an analysis of 49 cases

作　　者：张曦[1] 陈幸华[1] 高蕾[1] 孔佩艳[1] 刘红[1] 彭贤贵[1] 张诚[1] 高力[1] 王武[1] 孙爱华[1] 王庆余[1] 

机构地区：[1]第三军医大学新桥医院血液科,重庆400037

出　　处：《重庆医学》2010年第14期1834-1835,1838,共3页Chongqing medicine

基　　金：重庆市医学重点学科建设基金资助项目(2006C028)

摘　　要：目的观察无血缘关系供者外周血干细胞移植治疗急、慢性白血病的疗效。方法自2005年1月至2009年10月本科行无血缘关系供者造血干细胞移植治疗急、慢性白血病患者49例,供、受者之间人类白细胞抗原（HLA）配型全相合43例,HLA1个位点不合6例（其中,A位点不合2例,B位点不合1例,CW位点不合2例,DQ位点不合1例）。预处理方案环磷酰胺（CY）＋全身放疗（TBI）方案28例、BU/CY方案21例。采用环孢菌素A（CSA）＋骁悉＋甲氨喋呤（MTX）＋抗胸腺细胞球蛋白（ATG）预防性控制移植物抗宿主病。结果移植后10~23 d（中位时间14.8 d）中性粒细胞大于0.5×109/L;移植后13~27 d（中位时间18.6 d）,血小板大于20×109/L。14例（HLA1个位点不合者2例）发生Ⅱ度急性移植物抗宿主病（aGVHD）,予甲强龙治疗后控制,28例发生慢性移植物抗宿主病（cGVHD）,局限型14例,广泛型14例;无1例发生肝静脉闭塞病（VOD）及巨细胞病毒感染;移植相关毒副作用方面CY＋TBI方案与BU/CY方案差异无统计学意义;随访5~63个月,41例患者无病生存,8例死于本病复发和移植并发症;21例慢性粒细胞白血病bcr/abl融合基因检测转阴。结论无血缘关系供者外周血干细胞移植是一种有效的血液肿瘤治疗方法 。Objective To observe the therapeutic effect of unrelated-donor peripheral blood stem cell transplantation（URD-PBSCT） for acute/chronic leukemia.Methods 49 patients with acute/chronic leukemia received HLA completely matched/mismatched URD-PBSCT following conditioning regimens with cyclophosphamide（Cy）/TBI in 28 cases or busulfan（Bu）/Cy in 21 cases and prophylactic preventing graft-versus-host disease（GVHD） with cyclosporine A（CsA）/methotrexate（MTX）/Mycophenolate mofetil（MMF）/ATG（Thymoglobuline） in 49 cases from January 2005 to October 2009.Results The median days for reaching of neutrophil 0.5×109/L and platelet 20×109/L were＋14.8（range＋10～＋23） and＋18.6（range＋13～＋27） respectively after transplantation.Grade II acute GVHD had happened in 14 patients and was controlled by prednisolone.Limited and extensive chronic GVHD had happened each in 28 cases.None developed VOD and CMV infection.Transplantation-related side effect was not different between two conditioning regimens.Follow-up period after transplantation was 5 ~63months,41patients were disease free survival,8patients died of relapse.The fusion gene bcr/abl changed into negative in 21 cases of chronic granulocytic leukemia.Conclusion URD-PBSCT is an effective approach for the treatment of hematological malignancies.

关 键 词：外周血干细胞移植 无血缘关系供者 白血病 移植物抗宿主病 

分 类 号：R733.71[医药卫生—肿瘤]